5010 Enforcement Discretion Extended Thru June 30

The enforcement discretion period the Centers for Medicare & Medicaid Services (CMS) gave providers and payers to fully adopt the ASC X12 Version 5010 claim reporting standards is extended through June 30, the agency announced in a March 15 press release. This means CMS will not initiate enforcement action for an additional three months.

However, CMS’ Office of E-health Standards and Services (OESS) warns the extension is an opportunity to resolve lingering implementation issues, test systems, and training staff. Another extension is unlikely. Entities required to adopt the new standard are encouraged to solve collaboration problems and begin using the 5010 standard as soon as possible. Support and testing will be stepped up before July 1.

Ambulatory Surgical Center CASCC

For a slow, successful adoption of the Version 5010 standard by Jan. 1, CMS announced in November a 90-day non-enforcement discretion period. Health plans, clearinghouses, providers, and software vendors were encouraged to complete implementation, testing, and training.

CMS says steady progress is being made by payers and other entities toward implementation, citing successful receipt and processing for 70 percent of all Part A and 90 percent of Part B claims. The agency’s OESS, however, believes remaining issues warrant an extension to assure full implementation.

CMS says the OESS is stepping up its existing outreach to include more technical assistance for covered entities. The office is working with several industry groups to help payers, providers, facilities, and suppliers solve technical issues.


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